Why Is Your Most Complex Business System Disabling Healthcare?

If you are male, this piece will make perfect sense. If you are female, it will make even more sense.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture, a 15 minute project, total cost—nothing. After all, how difficult can that be? The actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet.

The obvious solution would have been to simply move the furniture back to its original position. Can’t do that. To move the furniture back is either admitting defeat, or that I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why—she will ask, that’s her job—there is a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer.

If you’re quick, really quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. What you’re really doing is stalling, allowing for a brief period of self-correction.

That truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say that I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much that will cost. This is a clear case of me answering her question without bothering to think. It’s important to have a clear understanding of the underlying issues before trying to solve the problem. I replied that it should cost $40, and that we will only need to leave the cable strewn across the floor for a few days.

It’s then her job to say that if we put the furniture back where it was we could solve both problems in 20 minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to healthcare.

Once her issues were out in the open was a simple matter to devise a solution to address them. The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floorboard, and then under the bed. That only left 5 feet of cable between a happy marriage and me. Unfortunately, the 5 feet in question is from the foot of the bed to the television and ran across the major walkway of the room.

Undaunted, I asked her to help me move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. Her look of dismay may have resulted because of the razor blade knife I was holding. After 20 minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I required was a roll of duct tape and a 4’11” broom handle. Women know we are confused about how to proceed the moment they see the duct tape. Most men, when cornered believe that enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note that I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the relevance of the length of the broom handle. Men on most projects, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

Hindsight dictates that I should have measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11” broom handle under a 5 foot expanse of wall-to-wall carpet.

The fact that the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain that the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now stuck under the carpet. And my wife, my east and my west, God love her, was perched on top of the bed’s footboard, with her talons firmly grasping the solid walnut. She stared at me with a look that would give carrion eaters a bad name.

Walking to the wall and grasping an edge of the carpet firmly, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been an inch too short. Leaning with my one arm on the newly exposed carpet tacks, I asked her to help me remove the handle from beneath the rug. Once that was accomplished, and while bleeding profusely, I looked for another proper tool to complete the task. Walking through the kitchen I wondered if the tool I needed was there. Naturally, it was; one half of a pair of chopsticks; also known by its new technical name, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I retrieved the handle and surveyed the situation. The situation, as it turns out, was that in my hand were a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the five foot expanse that I was trying to cross. The problem was that it was now on the wrong side of the carpet—the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick had just become a permanent fixture in the bedroom.

Certainly, one small chopstick hidden beneath 400 square feet of carpeting was not a big problem to me. It was not a problem unless you happened to be walking barefoot across the carpet and you happened not to be the one who put it there. In that case, it became not unlike the fable, The Princess and the Pea.

My princess found it immediately. In that fable, it was the princess could not sleep. In my case, I knew that the non-sleeper in the story would be me for as long as the chopstick remained under the carpet. Keeping my eyes focused firmly on the task at hand, I foolishly believed that if I could resolve the problem of the cable, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The carrion-eater looked on in disbelief at my inability to finish what I had started without us having to sell the house at a loss before I was through.

My project had become a quest. A mile of duct tape later, both broom handles were taped together end-to-end. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet. A minute later the cable emerged exactly where it should have, on the other side of the room. I pulled the out broom handle, attached the cable, and turned on the television. Everything worked, just as I had known it would.

I took a bow.

Standing in front of the television, admiring my work, I noticed that I was now a good foot taller than when I began the project. Was this an illusion brought about by my success? As was quickly pointed out by the ice princess, my new stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now compacted into a large lumpy ball. The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house, and I had placed it between my wife and my getting a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be able to feel the chopstick.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill.

I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained that it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why I would want to spend $300 for new padding. Without responding, he just kept slamming his knee into the carpet installer, charging $100 for his efforts and my education.

I was so impressed with his discussion of hardwood floors that I almost bought one on the spot to surprise my wife. By now, you and I know she wouldn’t have appreciated the surprise. Anybody who did not want to spend $40 on the cable repairman would probably have a little more trouble accepting spending $5,000 for a floor she didn’t need. However, I was able to walk around with a silent smirk on my face for days knowing that had we done it my way from the start, called the cable man, we could’ve saved the $100 and never put a hole in the carpet.

Now that I think about it, I should have waited until she was out shopping.

Did I mention healthcare?

This is what happens when you try to fix a problem with which you have no experience.

The largest business system in your organization, whether you work for a provider or a payer, is the system that interacts with your patients and your potential patients. It must interface well and easily with all of your other business and clinical systems.

Those people—patients, caregivers, family members, and referring physicians—need to talk to doctors and nurses. They need to solve problems and resolve disputes. They need to schedule appointments, set up payments plans, file claims, make a payment, order refills, ask questions about their health data, order their health records, and dozens of other things.

A non-trivial exercise. Like moving cable.

Sometimes it pays to get help. Or, you may be able to wait until everybody is out shopping.